CPT 22867 · Interspinous Spacer · Horizon BCBS NJ
Vertiflex — Interspinous Process Decompression (1st level) at Horizon BCBS NJ.
How Horizon BCBS NJ approaches CPT 22867 (Vertiflex — Interspinous Process Decompression (1st level)) for prior-authorization review: at last review on Date not on file, the policy does not cover this code with prior authorization required.
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N/AVerification pending. This record is awaiting confirmation against the latest policy document — criteria summary may not reflect the current revision.
Criteria summary
High-level themes from the Horizon BCBS NJ policy of record for CPT 22867. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 24 weeks of conservative care typically required.
- Imaging concordance documentation required.
Source: Horizon BCBSNJ — no standalone interspinous spacer bulletin located publicly
See the full Horizon BCBS NJ criteria.
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